Revision a1 pulley release: An analysis of risk factors using a national database. Weaver, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic: Trigger finger release - Revision risks This retrospective study assessed risk factors for revision surgery in people who underwent trigger finger release. More than 46,000 participants who underwent a single trigger finger release were included in the study. Revision surgery was assessed across all patients up to 5 years after surgery. The fingers with the highest probability or revision were the middle and ring finger, with the thumb being the least likely one. The overall revision surgery was 4%. Several variables (e.g. demographics, comorbidities) were included in models that controlled for confounding factors. The results showed that type 2 diabetes, cardiovascular conditions, older age, and the presence of carpal tunnel were all contributors to increased risk of revision surgery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, trigger finger revision is more likely in the middle and ring finger of people presenting with type 2 diabetes, who are older affected by carpal tunnel and cardiovascular conditions. The association between trigger finger and carpal tunnel syndrome is not new and this has been previously reported across several papers. In terms of most common trigger finger location, previous evidence has shed light on this condition being mostly prevalent in the middle finger, thumb, and ring finger. URL: https://doi.org/10.1016/j.jhsa.2024.09.016 Abstract Purpose: Trigger finger release (TFR) is a commonly performed procedure in hand surgery. Trigger finger release has a high success rate, but recurrence can occur. Data on revision TFR (rTFR) are sparse, with little known regarding factors associated with the need for revision surgery. Our purpose was to analyze risk factors associated with rTFR procedures. Methods: Using a national database (PearlDiver Research Program), patients who underwent TFR between 2015 and 2022 were identified using Current Procedural Terminology and International Classification of Diseases (ICD)-10 codes. Patients were included if they received an ICD-10 diagnosis of trigger finger on the same day as their release or within 2 weeks of their procedure. Patients who underwent rTFR were determined through identification of a secondary procedure completed in the same digit on the ipsilateral hand performed after the index procedure. Revision rates at 1, 3, and 5 years were recorded. Demographics and comorbidities were categorically examined via univariate and multivariable logistic regression analyses. Results: A total of 46,613 patients meeting inclusion criteria were identified after TFR with 1,793 (3.85%) undergoing revision release. Multivariable analysis demonstrated that diabetes, ischemic heart disease, and male sex were associated with statistically significantly increased odds of revision procedures at 1, 3, and 5 years from the initial operation. Age >65 years and hypertension were associated with an increased odds of revision surgery at 3 and 5 years, and carpal tunnel syndrome as a risk factor at 1 and 3 years only. Hypothyroidism was associated with a decreased revision rate at all time points and tobacco use at 5 years only. Conclusions: These data demonstrate that male sex, diabetes, and heart disease are risk factors for requiring revision TFR in the short and medium terms. This information can add to preoperative counseling with patients undergoing surgical treatment of trigger digits. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Preoperative vascular assessment of patients with a supracondylar humeral fracture and a perfused, pulseless limb. Holme (2023) Level of Evidence: 3a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: Vascular assessment - Pediatric elbow fractures This systematic review assessed the usefulness of objective tests in the assessment of vascular perfusion in children with a supracondylar humeral fracture presenting with a pulseless limb. Overall 25 studies were included in the review, for a total of 504 children. The results showed variability in clinical assessment methods, including color and capillary refill time (CRT), which may be limited in non-Caucasian patients. Ultrasound was considered useful for detailed vascular evaluation, but lacks standardised criteria for routine use. The authors recommend using CRT (with vascular compromise indicated by > 3 seconds refill) as a pragmatic cutoff, comparing it to the uninjured limb, and incorporating oxygen saturation measurements. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, the use of capillary refill time may be useful in the vascular assessment of children's with a supracondylar humeral fractures who do not present with a pulse. The refill time should be less than 3 seconds to provide some reassurance in terms of arterial supply. Alternatively, the use of temperature monitoring may be useful for non-Caucasion patients. If you are interested in supracondylar fractures have a look at the synopses on the topic. For another vascular presentation that we need to be aware of, this synopsis is on hypothenar hammer syndrome. URL: https://doi.org/10.1302/0301-620x.105b3.bjj-2022-0699.r2 Abstract Aims: The ‘pink, pulseless hand’ is often used to describe the clinical situation in which a child with a supracondylar fracture of the humerus has normal distal perfusion in the absence of a palpable peripheral pulse. The management guidelines are based on the assessment of perfusion, which is difficult to undertake and poorly evaluated objectively. The aim of this study was to review the available literature in order to explore the techniques available for the preoperative clinical assessment of perfusion in these patients and to evaluate the clinical implications. Methods: A systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered prospectively with the International Prospective Register of Systematic Reviews. Databases were explored in June 2022 with the search terms (pulseless OR dysvascular OR ischaemic OR perfused OR vascular injury) AND supracondylar AND (fracture OR fractures). Results: A total of 573 papers were identified as being suitable for further study, and 25 met the inclusion criteria for detailed analysis. These studies included a total of 504 patients with a perfused, pulseless limb associated with a supracondylar humeral fracture. Clinical examination included skin colour (23 studies (92%)), temperature (16 studies (64%)), and capillary refill time (13 studies (52%)). Other investigations included peripheral oxygen saturation (SaO2) (six studies (24%)), ultrasound (US) (14 (56%)), and CT angiogram (two studies (8.0%)). The parameters of ‘normal perfusion’ were often not objectively defined. The time to surgery ranged from 1.5 to 12 hours. A total of 412 patients (82%) were definitively treated with closed or open reduction and fixation, and 92 (18%) required vascular intervention, ranging from simple release of entrapped vessels to vascular grafts. Conclusion: The description of the vascular assessment of the patient with a supracondylar humeral fracture and a pulseless limb in the literature is variable, with few objective criteria being used to define perfusion. The evidence base for decision-making is limited, and further research is required. We were able, however, to make some recommendations about objective criteria for the assessment of these patients, and we suggest that these are performed frequently to allow the detection of any deterioration of perfusion. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Updating risk and protective factors for dementia in older adults. Rodriguez, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (2/4 Thumbs up) Type of study: Aetiologic Topic: Brain health - Protective factors This narrative review highlights emerging evidence on population-level and individual-level factors influencing the risk of age-related dementia. The authors identified post-traumatic stress disorder, bipolar disorder, psychotic disorders, anxiety, and ultra-processed food consumption as high-risk factors. Protective factors included fruit and vegetable intake, purpose in life, residential greenness, and musical instrument play. Both population-level strategies, such as policy changes and individual-level approaches were suggested. These include lifestyle modifications and the use of digital tools (e.g. cognitive training, mindfulness programs) for the prevention of this disease. The authors also suggest that these approaches need to be adapted across different communities for the development of effective interventions. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, mental health appears to be an important factor in the prevention of dementia. Considering that people with upper limb conditions can become depressed and anxious due to their injury, we play an important role in reducing their long term risk by providing good care for them. Furthermore, helping them to stop smoking also reduces their overall risk. Furthermore, keeping them mentally active by encouraging them to play games, use computers rather than watching TV, are additional strategies that can reduce their dementia risk. I am also reminding us, that simple physical exercise can have a large impact. URL: https://doi.org/10.1038/s44159-025-00438-w Abstract Promoting good cognitive functioning and preventing dementia in late life are priority actions for many countries with rapidly ageing populations. Although epidemiological research has established some modifiable factors that influence the risk of cognitive impairment (such as low education level, hearing impairment, smoking, obesity, physical inactivity or social isolation), a growing literature suggests further risk and protective factors that might affect cognitive functioning and dementia. In this Review, we examine the potential effects of these less well-established factors, and discuss promotion and prevention strategies at the population and individual levels that might reduce dementia risk in the long term. Reducing financial struggles, neighbourhood deprivation and workplace strain and promoting leisure activities, emotional wellbeing and healthy nutritional styles have emerged as factors that might help to prevent dementia and could be included among priority actions for healthy cognitive ageing. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Proximal humeral fractures in patients over 60 years old: A randomized study of nonoperative versus operative treatment with locking plate. Gracitelli, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: Proximal humerus fractures - Conservative vs surgical management This randomised controlled study assessed the effectiveness of open reduction internal fixation vs conservative management of displaced proximal humerus fractures in people over 60 years old. A total of 71 participants were included in the present study with 40 participants randomised to conservative management and 31 to surgical management. Outcomes of interest included shoulder function, complications rates, and overall perceived improvement and they were measured at 3, 6, 12, and 24 months. The results demonstrate showed that both groups had comparable outcomes in terms of function and overall perceive improvements. The surgical group experienced a higher complication rate (35.5% vs. 15.0%), however, this difference was not statistically significant. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, for displaced proximal humerus fractures in patients over 60 years old, nonoperative management is equally effective as open reduction internal fixation. Function, overall improvement, and complication rates are similar, with neither approach being superior. Physiotherapy plays a crucial role in both approaches with the aim of monitor healing and improving shoulder flexibility. Most of our patients with humeral fractures also present with a hand/wrist fracture/injury; remember that the longer we immobilise these wrists, the worst their shoulder function tends to be. Get them moving if you can. Following such humeral fractures, it is also possible to develop a frozen shoulder and hydrodilatation +/- CSI seem to be helpful. If you want to know more of how to help your patients with shoulder conditions, have a look at the whole database. URL: https://doi.org/10.1016/j.jse.2024.12.036 Abstract Background: Proximal humerus fractures (PHFs) are common in the elderly, with a rising incidence. Despite advances in surgical techniques, the optimal treatment for displaced PHFs remains controversial, as high-quality studies show no significant differences in functional outcomes between surgical and nonsurgical treatments. This study aims to compare nonoperative with surgical treatment using a locking plate (LP) for displaced PHFs in patients over 60 year old. Methods: This prospective, randomized clinical trial compared nonoperative and operative treatments using LPs for displaced PHFs in patients over 60 year old. Patients were randomized 1:1 into 2 groups using a block randomization stratified by tuberosity involvement. The primary outcome was the Constant-Murley score at 24 months. Secondary outcomes included the Individual Relative Constant Score, American Shoulder and Elbow Surgeons (ASES) score, and Single Assessment Numeric Evaluation (SANE) score at 3, 6, 12, and 24 months. The incidence of complications and the need for reoperations were evaluated. Results: Eighty patients were randomized, with 71 completing 24 months of follow-up: 40 in the non-operative group and 31 in the operative group. At 24 months, the mean Constant-Murley scores were 68.7 ± 16.1 for the non-operative group and 66.5 ± 15.8 for the operative group (P = .433). The ASES score at 24 months was 77.0 ± 23.1 for the nonoperative group and 79.1 ± 20.0 for the operative group (P = .871). The SANE scores at 24 months were 83.8 ± 19.3 for the nonoperative group and 88.5 ± 17.2 for the operative group (P = .236). The Individual Relative Constant Score at 24 months was 79.5 ± 25.2% for the nonoperative group and 73.0 ± 29.2% for the operative group (P = .244). Seventeen patients experienced complications, with 6 (15.0%) in the nonoperative group and 11 (35.5%) in the operative group (P = .070). The rate of a new surgical indication was 12.5% in the nonoperative group and 22.6% in the operative group (P = .421). Rotator cuff tears were 20.0% in the nonoperative group vs. 25.8% in the operative group (P = .768). Conclusion: The operative treatment of displaced proximal humeral fractures with LP osteosynthesis in patients over 60 year old shows no evidence of differences in clinical outcomes compared to nonoperative treatment, as measured by the Constant-Murley Score, Individual Relative Constant Score, ASES, SANE, and complication rates. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Effect of time from injury to surgery on surgical technique and complication rate in distal biceps tendon repair. Morrison, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Distal biceps repair - Type of surgery This study retrospective study assessed the relationship between the time elapsed from injury to surgery and the surgical technique used for distal biceps tendon ruptures. A total of 373 patients were included. The results showed that three main types of surgery were completed and that these were associated with time from injury. In particular, direct repair was predominantly performed for acute injuries, occurring within 16 days of injury on average, while high flexion angle repair and allograft reconstruction were more commonly used in chronic cases with longer delays, averaging 82 and 274 days, respectively. The three types of surgeries were equally like to happen at 25-27 weeks post-injury. Complication rates were low overall (12%), with isolated sensory nerve injuries being the most frequent complication (either superficial branch of the radial nerve or posterior interosseous nerve). There were no significant differences in re-rupture or major complication rates between surgical techniques. Probability of surgical technique based on time from injury to surgery. DR = direct repair; HFA = high flexion angle repair; AR = allograft reconstruction. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, the type of surgery for a distal biceps repair is highly dependent on the time from injury. Direct Repair is used for acute injuries (within 16 days). High Flexion Angle Repair occurs when the repair is completed "under tension" as the surgeon is unable to repair the distal biceps unless the elbow is flexed to 60deg or 100deg. An alternative to this is completing and allograft repair, often with a palmaris longus. These two repairs are much more likely if injury occurred 7-8 months after injury. In the case of these last two repairs, a hinged ROM brace is likely required, especially for the high flexion angle approach, to avoid re-rupture. URL: https://doi.org/10.1016/j.jse.2025.07.027 Abstract Background: Surgical treatment options for distal biceps tendon ruptures vary based on time from injury to surgery. While direct repair (DR) is preferred for acute injuries, high flexion angle repair (HFA) and allograft reconstruction (AR) are alternatives for chronic cases. This study examines the relationship between time to surgery, surgical technique selection, and complication rates. Methods: A retrospective chart review was conducted on patients treated surgically for distal biceps tendon ruptures at a single center from January 2012 to June 2023. Cases were identified through electronic medical records and included patients ≥18 years with unilateral ruptures. Demographics, time to surgery, surgical techniques (DR, HFA, AR), and complications were recorded. Descriptive statistics and multinomial logistic regression were used to assess the association between time to surgery and surgical technique. Results: A total of 373 patients were included, with 90% undergoing DR (n=334), 6% HFA (n=22), and 5% AR (n=17). The mean (standard deviation) time from injury to surgery was 16 (±30) days for DR, 82 (±162) days for HFA, and 274 (±455) days for AR. Surgical technique selection was significantly associated with time to surgery (Kruskal Wallis p<0.001), with DR favored in acute cases and HFA/AR in chronic presentations. The inflection point for equal probabilities of DR, HFA, and AR occurred at 25-27 weeks post-injury. The overall complication rate was 12% (n=45), with nerve injuries being the most common (7%, n=25). Conclusion: Timing significantly impacts surgical technique selection in distal biceps tendon ruptures. DR remains the standard for acute injuries, while HFA and AR are viable options for chronic cases. The multinomial probability graphic (Figure 2) can be used to educate and council patients on surgical decision making for chronic distal biceps ruptures. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Supervised machine learning and clinical decision support. Bukowiec, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic: Machine learning - Human supervision The expert opinion provides an overview of supervised machine learning (ML) in clinical settings. It highlights its applications, challenges, and ethical considerations. Supervised ML involves training models using labeled data to predict outcomes or classify patterns, making it valuable for analysing electronic health records (EHRs), medical imaging, and treatment recommendations. Examples include predicting patient risks, diagnosing fractures, and automating radiographic positioning. However, challenges such as overfitting (models working great on dataset but not on new patients), underfitting (models not findings a pattern), have implications for broad implementation of models, which require human supervision. Furthermore, ethical concerns include bias in AI systems exacerbating disparities amongst social or ethnic groups. Additionally, issues like patient privacy, regulatory frameworks, and implementation barriers hinder widespread adoption. Overall, the authors state that human supervision will be paramount in the use of these tools across, reasearch, patient care, and evidence based medicine. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, supervised machine learning offers significant advancements in clinical settings, including applications like risk prediction, diagnosis, and adoption of evidence based medicine. However, its implementation must address several key challenges: ensuring that models generalise well across diverse populations and new patients, control for bias to avoid widening of inequitable care, transparency for trust, and maintenance of patient privacy. Another key aspect for implementation of these tools includes the education of clinicians in their use for successful adoption. For your information, some of the currently available tools include a scaphoid fracture probability prediction and another one on the probability of patients with carpal tunnel syndrome to positively respond to surgery. If you want to learn more about the use of artificial intelligence for hand therapy, look at the whole database. URL: https://doi.org/10.1016/j.hcl.2025.08.001 No Abstract available publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Integrating point-of-care ultrasound in hand clinic: A systematic review and meta-analysis. Perlmutter, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic: US imaging - Hand fractures This systematic review assess the usefulness of point-of-care ultrasound (POCUS) in diagnosing common hand pathologies such as fractures, tendinopathies, and nail injuries. Fifteen studies for a total of 1,217 participants were included in the review. The results showed that POCUS exhibits high diagnostic accuracy, particularly for hand and wrist fractures, with a pooled sensitivity of 82% and specificity of 89%. Trigger fingers and tendon lacerations were also easily identified via US imaging. For nail pathologies, POCUS achieves 97% sensitivity and 95% specificity in detecting subungual hematomas. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, US imaging in the clinic may be particularly useful in identifying hand/wrist fractures as well as tendon lacerations and pathologies. The main issue is that diagnostic ability is operator dependent. As you are probably aware, there is a series of additional uses for US imaging in clinic, which include the assessment of carpal tunnel syndrome, cubital tunnel syndrome, and the presence of intra-articular swelling at the elbow (suggestive of fractures). If you want to know more about US imaging for hand and upper limb therapy, have a look at the whole database. URL: https://doi.org/10.1016/j.jhsg.2025.100775 Abstract Purpose: Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable adjunct to physical examination in various clinical settings. Despite this, integration into the routine clinical practice of hand surgeons remains limited. This systematic review and meta-analysis aims to evaluate the diagnostic and clinical utility of POCUS in hand clinics for the assessment and management of common hand pathologies. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, MEDLINE and Embase were searched. Prospective studies evaluating POCUS use in hand pathologies were included. Two reviewers independently screened, extracted, and assessed data. Meta-analysis of diagnostic performance measures was conducted using a bivariate random effects model when appropriate. Results: Fifteen prospective studies involving 1,217 patients were included. POCUS was most commonly used to assess fractures (76.3%) and tendinous pathologies (20%). For hand fractures, pooled sensitivity and specificity were 81.95% (95% confidence interval [CI]: 78.03% to 85.31%) and 89.39% (95% CI: 87.12% to 91.30%), respectively. Among tendinous pathologies, POCUS demonstrated 100% sensitivity for trigger digits in three of four included studies. Limited evidence also supported high diagnostic performance for nail bed injuries (sensitivity: 97%, specificity: 95%). Conclusions: POCUS demonstrates high diagnostic accuracy for evaluating hand fractures and tendinous injuries while showing promise in the evaluation of nail bed trauma. Heterogeneity in study design, operator expertise, and reference standards was noted. Clinical relevance: The incorporation of POCUS into the clinical practice of hand surgeons, supported by formal training and technological advancements such as artificial intelligence integration, may improve diagnostic efficiency, guide management, and enhance care delivery. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Evaluating the impact of trauma on carpal tunnel syndrome onset and postsurgical recovery: A retrospective study in orthopedic practice. Ellingwood, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic Topic: CTS - Traumatic onset This retrospective study assessed outcomes in patients with carpal tunnel syndrome (CTS), focusing on the impact of trauma history, workers' compensation status, and other demographic and clinical factors. A total of 478 participants were included who had undergone CTS surgery. Pain levels (measured via visual analog scale) between patients with traumatically induced CTS and those without a trauma history were assessed. The results showed that individuals with a trauma-related diagnosis presented with higher initial and final pain scores, however, these were not clinically relevant (less than 1 point out of 10 more). Additionally, there was a trend for workers' compensation status predicting increased pain levels and prolonged length of care, suggesting that psychological or economic stress related to claims may contribute to poorer outcomes. Comparing estimated adjusted geometric means and 95% CI for the interaction between upper extremity diagnosis and workers’ compensation regarding length of care(in weeks). Light blue bars represent no workers’ compensation, whereas dark blue represents workers’ compensation. “*” indicates a statistically significant difference between thetwo means, with a P value < .05. For the upper extremity diagnosis, 0 ¼ No Additional Upper Extremity Diagnosis, 1 ¼ An Additional Upper Extremity Diagnosis on one side(Unilateral), and 2 ¼ Additional Upper Extremity Diagnoses on both sides (Bilateral). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, carpal tunnel syndrome can be cause by trauma and that with this onset, pain levels can be slightly higher compared to insidious onsets. Workers' compensation status also appears to be associated with higher symptoms and longer recovery time. Remember that making a carpal tunnel diagnosis should rely on orthopaedic tests reproducing symptoms in the median nerve sensory distribution/identify sensory loss rather than only reproduce patients' symptoms. Also remember that the extend of biological changes to the nerve do not predict how much of an improvement we get following carpal tunnel release. This should be kept in mind when discussing expectations prior to surgery with patients. URL: https://doi.org/10.1016/j.jhsg.2025.100774 Abstract Purpose: The purpose of this study was to investigate the relationship between previous trauma to upper extremities and the subsequent development of carpal tunnel syndrome (CTS). By comparing cases of traumatically induced CTS with idiopathic CTS, the study aims to evaluate differences in symptom severity and postsurgical treatment outcomes. Additionally, the study explores other factors associated with higher pain scores and longer lengths of care. Methods: A retrospective study was conducted on patients who underwent carpal tunnel release surgery by a single hand surgeon from January 1, 2014 to October 1, 2020. Pre- and postoperative care duration and pain levels, assessed using a visual analog scale, were the primary outcomes. To analyze the predictors of pain levels and recovery time, unadjusted means were generated, followed by the development of a model to account for potential correlations and contributions. Results: The study included 478 patients (324 women and 154 men) with a mean age of 53.2 years, all of whom underwent carpal tunnel release surgery. Patients with traumatic injuries had higher initial and final pain scores compared with those with nontraumatic causes. Notably, trauma was not a significant factor in the length of care model, despite its association with pain scores. Meanwhile, worker’s compensation was a factor associated with prolonged length of care. Conclusions: This study demonstrates that traumatic injuries and other factors, such as worker’s compensation, gender, and race/ethnicity, significantly influence both pain levels and length of care in patients undergoing carpal tunnel release surgery. These findings emphasize that CTS can develop after trauma and is not exclusively idiopathic. Addressing various clinical and socioeconomic factors is essential for enhancing treatment effectiveness and managing expectations following surgery. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Exploring health and financial literacy in patients with peripheral nerve injury: A cross-sectional analysis of patients treated surgically. Goldfarb, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Economic Topic: Financial literacy - Patients with peripheral nerve injury This cross-sectional study assessed health and financial literacy among patients with peripheral nerve injuries. A total of 21 participants were included in the study. Validated scales were utilised to assess participants' ability to navigate healthcare and understand financial systems. The results showed that patients demonstrated high health literacy across nine domains, comparable to other patient groups such as those with psoriasis or heart failure. However, financial literacy scores were moderate, with patients answering 70% of questions correctly on average, indicating variability in their understanding of financial concepts. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, peripheral nerve injury patients exhibit strong health literacy but only moderate financial literacy (~70%). This may be quite problematic due to them being potentially not prepared for the direct (e.g. medical/surgical) or indirect (e.g. being off work) cost. It may therefore be relevant for us to integrate financial education into our patient management to address challenges such as budgeting and insurance navigation. This would make sense especially considering that more socially deprived patients tend to have on average worse outcome across all presentation. Furthermore, in our pre-surgical consultations, it may be useful to indicate the time off work and the rehabilitation process, to avoid breaching their expectations, which in turns drives their satisfaction with the care provided. URL: https://doi.org/10.1016/j.jhsg.2025.100787 Abstract Purpose: Health literacy influences patient outcomes and recovery in musculoskeletal conditions. Although financial distress is common after orthopedic injuries, the role of financial literacy in these patients is unknown. We aimed to evaluate health and financial literacy in patients recovering from peripheral nerve injuries (PNI). Methods: After obtaining institutional review board approval, this cross-sectional study surveyed 21 patients with either PNI or brachial plexus injuries via phone. Two validated instruments were administered: the Health Literacy Questionnaire, comprising 44 items across nine independent domains, and a 23-item Financial Literacy Questionnaire assessing a range of financial literacy concepts. Descriptive statistics summarized scores on both surveys. Results: Participants had a mean age of 52.3 ± 15.8 years; 38% were women. The Health Literacy Questionnaire results demonstrated uniformly high health literacy across all domains, with the highest scores observed in domains related to active engagement with health care providers, understanding health information, and social support. In contrast, financial literacy, measured by the overall percentage of correct responses on the Financial Literacy Questionnaire, averaged 70% ± 20% (range: 21.7% to 91.3%), indicating moderate financial literacy with substantial interpatient variability. Conclusions: Patients recovering from PNI possess high levels of health literacy across nine different domains, comparable with populations with chronic conditions such as psoriasis, heart failure, and those undergoing dialysis. However, moderate and variable financial literacy suggests that despite effective health care system navigation, many patients may be less equipped for the financial challenges associated with their injury. These findings highlight the potential benefit of integrating targeted financial education into the perioperative management of PNI patients. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Incidence and risk factors for soft tissue hand and wrist conditions in pregnancy and postpartum. Smith, et al. (2025) Level of Evidence: 3b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic: Pregnancy - Hand conditions This retrospective study assessed the incidence of hand conditions, namely De Quervain’s Tenosynovitis (DQT), Trigger Finger (TF), and Carpal Tunnel Syndrome (CTS) in pregnant and postpartum women. A total of 715,337 women were included in the paper. The sample was subdivided by pregnancy, diabetes, and gestational diabetes. The results showed that pregnancy was associated with an increased risk of DQT, but not, by itself, with an increased risk of CTS or TF. However, if gestational diabetes was present, this increased all hand conditions risk (DQT, CTS, and TF). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, De Quervain’s Tenosynovitis is more likely in pregnant compared to non pregnant women and it occurs on average in 1 in 100 pregnant women. If pregnancy is associated with gestational diabetes, the odds of developing Trigger Finger and Carpal Tunnel Syndrome also increase. You could therefore suggest your pregnant clients to be physically active as that is a way of keeping gestational diabetes under control, alongside a healthy diet rich in fibres. Additionally, following the WHO guidelines for physical activity could be a population based intervention to prevent the risk of developing trigger finger and carpal tunnel syndrome during pregnancy. If you want to know more about De Quervain, Trigger Finger, or Carpal Tunnel Syndrome, you have a ton of synopses to look at :) URL: https://doi.org/10.1016/j.jhsg.2025.100778 Abstract Purpose: This study aimed to identify the incidence of and risk factors associated with soft tissue hand conditions in pregnancy and postpartum. We hypothesized that the incidence of de Quervain tenosynovitis (DQT) and possibly carpal tunnel syndrome (CTS) and trigger finger would be higher in pregnancy and postpartum and that gestational diabetes would be a risk factor for these conditions. Methods: Using the PearlDiver administrative claims database, we identified pregnant females undergoing vaginal or Cesarean delivery from 2011 to 2022. This cohort was propensity score matched based on age and Elixhauser comorbidity index to females who were not pregnant. We identified pregnant females with a diagnosis of gestational diabetes. Multivariate regression models were used to assess the risk of developing a hand condition within the first year postpartum, adjusting for age, geographical region, insurance plan, comorbidity index, and inflammatory arthritis or diabetes diagnosis. We applied these models to evaluate the risk of developing a hand condition in gestational diabetes patients. Results: We identified a cohort of 357,534 postpartum patients and 357,803 control patients. We observed a 1.5% incidence of hand conditions postpartum compared to 1.3% in the control population (P < .001). Pregnancy was associated with an increased risk of diagnosis with DQT (odds ratio [OR], 5.11; 95% confidence interval [CI], 4.47–5.85; P < .001). Gestational diabetes was also associated with an increased risk of a hand condition diagnosis (OR, 1.34; 95% CI, 1.26–1.42; P < .001), specifically increased odds of CTS (OR, 1.40; 95% CI, 1.29–1.51; P < .001) and DQT (OR, 1.23; 95% CI, 1.12–1.34; P < .001). Conclusions: Pregnancy is a significant risk factor for hand conditions and was associated with increased odds of DQT. Gestational diabetes is a significant risk factor for CTS and DQT. Our findings can inform screening and patient education efforts for high-risk pregnant patients. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Determining risk factors and rate of surgery after collagenase injections for dupuytren contracture. Cha, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: Alcohol & Smoking - Dupuytren recurrence This retrospective study assessed the recurrence of Dupuytren contracture following collagenase treatment and identified risk factors associated with subsequent surgical intervention. A total of 14,805 patients were included in the study. Out of the whole sample,10% of patients underwent surgical intervention within five years. Patients who were smokers were more likely (13%) to undergo open surgery compared to non smokers. In addition, of the patients with alcohol use disorder (avoid use the term alcoholic as it is stigmatising) 16% had to undergo surgery. Other factors, such as diabetes, epilepsy, and vascular disease, did not seem to affect surgical intervention rates. Incidence rates (%) of surgical correction within 5 years among patients with Dupuytren contracture, categorized by the presence or absence of specific risk factors. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, Dupuytren contracture recurrence after collagenase is significantly higher in people who smoke or those with an alcohol use disorder. It is therefore important to counsel our patients and help them living a healthier lifestyle. Helping our clients to stop smoking and drinking is therefore part of our role in our aim to prevent the need for further surgery for Dupuytren. Considering that smoking comes with a plethora of complications for our patients, including higher risk of tendon repair failure, infections, and ongoing symptoms, it is worth our time investment. URL: https://doi.org/10.1016/j.jhsg.2025.100768 Abstract Purpose: Collagenase injections are a nonsurgical treatment for Dupuytren contracture, but their long-term effectiveness in preventing surgery remains unclear. This study aimed to evaluate the rate of surgical intervention following collagenase treatment and identify whether specific risk factors increase the likelihood of future surgical correction. Methods: This retrospective cohort study utilized the TriNetX US Collaborative network to identify patients diagnosed with Dupuytren contracture between January 2007 and September 2024. Patients initially treated with collagenase injections were identified using relevant current procedural terminology codes. Procedure-specific current procedural terminology codes were then used to determine which patients underwent a subsequent fasciectomy or fasciotomy within 5 years of their initial injection. Risk factors, including smoking, diabetes, alcohol abuse, epilepsy, and vascular disease, were identified by International Classification of Diseases, 10th Edition codes. Statistical analysis was performed to evaluate the association between these risk factors and the likelihood of undergoing surgery. Results: Among 6,917 patients identified to have been treated with collagenase, 715 (10.2%) underwent surgery within 5 years of the injection. Tobacco use was associated with a significantly higher rate of surgery (12.98%, P = .03) compared with nonsmokers (10.1%). Similarly, patients with alcohol use disorder had a higher surgical correction rate (16.3%, P < .001) compared with those without (9.8%). Conclusions: Approximately 10% of patients treated with collagenase injections for Dupuytren contracture underwent surgery within 5 years. Smoking and alcohol use significantly increased the likelihood of surgery, representing a potential correlation. Further research is warranted to explore mechanisms underlying progression to surgery and prevention strategies. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

A meta-analysis of technology use and cognitive aging. Benge, et al. (2025) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: Technology use - Cognitive preservation This systematic review and meta-analysis assessed the association between natural (not imposes) digital technology use (e.g., computers, phones, tablets) and cognitive decline in older adults. A total of 411,430 middle-age to older participants were included from cross-sectional and longitudinal studies. The results showed that higher levels of technology use were linked to a reduced risk of cognitive decline or dementia in both cross-sectional and longitudinal studies. Meta-regressions and sensitivity analyses (correction for certain variables) showed that study design, socioeconomic status, education, comorbidities, or social support did not blunt the positive effect of technology use (see picture below, which is showing the reduced odds - below 1 - of cognitive decline whilst controlling for several factors). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, technology use is protective against cognitive decline/dementia in older adults independently of comorbidities, socioeconomic status, educational level, or social support. Considering that the negative influence of technology on the musculoskeletal system has been debunked in the hand and neck, we should encourage our middle age/older patient to be involved in the use of technology. If you combine use of technology with a bit of gaming and physical activity, you are likely to improve their mental health alongside their upper limb musculoskeletal pain/syndromes. URL: https://doi.org/10.1038/s41562-025-02159-9 Abstract The first generation who engaged with digital technologies has reached the age where risks of dementia emerge. Has technological exposure helped or harmed cognition in digital pioneers? The digital dementia hypothesis predicts that a lifetime of technology exposure worsens cognitive abilities. An alternative hypothesis is that such exposures lead to technological reserve, wherein digital technologies promote behaviours that preserve cognition. We tested these hypotheses in a meta-analysis and systematic review of studies published in Medline, PsycInfo, CINAHL, Science Direct, Scopus, Cochrane Library, ProQuest and Web of Science. Studies were included if they were observational or cohort studies focused on general digital technology use in older adults (over age 50) and included either a cognitive or dementia diagnosis outcome. We identified 136 papers that met inclusion criteria, of which 57 were compatible with odds ratio or hazard ratio meta-analysis. These studies included 411,430 adults (baseline age M = 68.7 years; 53.5% female) from cross-sectional and longitudinal observational studies (range: 1–18 years, M = 6.2 years). Use of digital technologies was associated with reduced risk of cognitive impairment (OR = 0.42, 95% CI 0.35–0.52) and reduced time-dependent rates of cognitive decline (HR = 0.74, 95% CI 0.66–0.84). Effects remained significant when accounting for demographic, socioeconomic, health and cognitive reserve proxies. All studies were evaluated for quality on the basis of a standardized checklist; the primary outcomes replicated when limiting analyses to the highest-quality studies. Additional work is needed to test bidirectional causal interpretations, understand mechanisms that underpin technological reserve, and identify how types and timings of technology exposures influence cognitive health. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings